Laudanosine and atracurium concentrations in a patient receiving long-term atracurium infusion

Critical Care Medicine
A M GrigoreR Koorn

Abstract

Atracurium is sometimes used for muscle relaxation in patients undergoing mechanical ventilation. Use of atracurium in high doses or for a long period of time has raised the possibility of the accumulation of laudanosine, a breakdown product known to cause seizure activity in animals. The objective of this report was to see if laudanosine accumulation and seizure activity had occurred in a patient who had received a long-term, relatively high-dose infusion of atracurium. Case report. The patient received atracurium for 38 days, at rates ranging from 0.3 to 0.96 mg/kg/hr. An electroencephalogram (EEG) was done before the discontinuation of the infusion, and plasma concentrations of atracurium and laudanosine were measured at, and after, the termination of the atracurium infusion. The laudanosine elimination half-life was calculated. Intensive care unit. A 23-yr-old woman admitted with sickle cell crisis, complicated by acute chest syndrome, acute respiratory distress syndrome, and hepatic and renal failure. None. As expected, laudanosine concentrations were increased but were below the level reported to cause seizure activity in animals. Laudanosine elimination half-life was prolonged to 617 mins, which was consistent with previ...Continue Reading

References

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Citations

Feb 6, 2002·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·UNKNOWN American College of Critical Care Medicine of the Society of Critical Care Medicine, American Society of Health-System Pharm
Jul 3, 2002·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Kate Leslie, Sally Troedel
Jul 13, 2002·European Journal of Anaesthesiology·V Fodale, L B Santamaria
Sep 5, 2013·Critical Care Nursing Quarterly·Jerry Altshuler, Brian Spoelhof
Mar 21, 2002·Critical Care Medicine·Michael J MurrayUNKNOWN Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), America

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